Researcher sees promise in new treatment for common skin cancer

Extreme heat and plenty of sunshine is a given for Atlanta, especially this summer. In June, there were nearly 285 hours of sunshine, and it's on track for more rays this month, according to U.S. Climate Data.

That's a lot of UV radiation exposure—a form of energy the sun produces—and a potential risk for skin cancer, the most common form of cancer by far.

While the vast majority of skin cancers are highly treatable when caught early, if left untreated they can become invasive, grow into deeper layers of the skin and spread to other parts of the body.

A new clinical trial at Winship Cancer Institute of Emory University in Atlanta is testing a new type of radiation treatment for people facing a recurrence of a specific form of skin cancer: squamous cell carcinoma. It is the second most common form of skin cancer.

While this trial will not include other types of skin cancer, including melanoma, the deadliest form of skin cancer, Dr. Zachary Buchwald, a radiation oncologist and cancer immunology researcher at Winship, said this treatment could potentially be used to treat other skin cancers.

This investigational treatment is new in the kind of radiation used to treat the cancer and how the radiation therapy is administered.

Typical radiation therapy requires regular visits to a hospital and a large machine is used to direct high-energy X-ray beams onto a precise point on the body.

Emory's trial studies a new way to administer radiation by inserting tiny "seeds" that are about the size of a grain of rice underneath the skin at the precise location of the cancerous tumor. Buchwald said the seeds are like "grains of rice on a string" and are injected with a simple needle procedure.

"We basically deposit the seeds in a lattice network to cover the whole tumor," he said.

The targeted treatment also minimizes damage to surrounding healthy tissue.

The treatment is administered during an outpatient visit and remains in place for two weeks, at which point the patient returns and it is removed. Buchwald noted this is convenient for patients, so they don't have to make daily visits for radiation treatment, especially for patients who must drive long distances to reach Emory's Winship Cancer Institute on Clifton Road in Atlanta.

The seeds give off a type of high-energy radiation, known as alpha radiation, to kill cancer cells. People may be familiar with a prostate cancer treatment using similar technology and requiring the radioactive seeds to be implanted in the prostate. But Buchwald noted this investigational treatment uses a different type of radioactive substance.

The trial is accepting new patients grappling with the return of this form of cancer. There is no cost for participating in the trial and participants don't need to be Emory Healthcare patients.

While early in the trial, Buchwald said he's hopeful and encouraged by some early "impressive results."

"I had this patient who had like multiple, multiple recurring squamous cell carcinomas around his nose. And unfortunately, he had to have a total rhinectomy, so his nose was basically removed. He had prior radiation, multiple surgeries and was kind of at his wit's end in terms of getting his cancer under control. We treated him in December as part of the trial and he had no evidence of recurrent disease at that time."

There are no statistics on how many people will develop or die from squamous skin cancer. Basal and squamous cell skin cancers are the most common forms of skin cancer and are not tracked by cancer registries.

Melanoma is the least common but most serious form of skin cancer, and it is tracked by health authorities. In 2021, the latest year for which data are available, in the United States, 90,365 new cases of melanoma were reported by the CDC's U.S. Cancer Statistics, meaning for every 100,000 people, 23 new cases were reported.

In Georgia, the rate was slightly higher. In 2021, there were 2,986 new cases of melanoma, equivalent to 25 cases for every 100,000 people.

Most squamous cell cancers are caused by too much ultraviolet radiation, which is a type of light that comes from sunlight or tanning beds. The UV index is a method of predicting how strong UV rays will be outdoors. The higher the UV index, the less time it takes for skin to become damaged by the sun.

It's estimated one in five Americans will have skin cancer over their lifetime. Skin cancer rates in Georgia are higher than the national average, according to the Centers for Disease Control and Prevention.

"The average rate of skin cancer relative to the rest of the United States is higher because we have a lot more high UV days here," Buchwald said about Georgia. "And perhaps people may not have good adherence to sun hygiene like wearing sunscreen."

He said a lack of access to dermatologists, especially in rural areas, may also play a role because it can mean people delay getting skin cancer screenings or skip them altogether.

Sometimes skin cancer signs aren't all that obvious.

Buchwald recommends people pay attention to "any new bumps that pop up and kind of persist especially in sun-exposed areas, so on your shoulders, on your face, your back. Anything that looks a little bit abnormal, they can look crusty or a little red bump, anything that pops up on your skin and lingers I think really needs to be evaluated by a dermatologist with a biopsy."

Spotting skin cancer

Skin cancer appears on the body in many different ways. It can look like a:

• Changing mole or mole that looks different from your others
• Dome-shaped growth
• Scaly patch
• Non-healing sore or sore that heals and returns
• Brown or black streak under a nail

It can also show up in other ways.

To find skin cancer on your body, you don't have to remember a long list. Dermatologists sum it up this way. It's time to see a dermatologist if you notice a spot on your skin that:

• Differs from the others
• Changes
• Itches
• Bleeds

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